The New York Times - November 17, 1986
Lawrence K. Altman

The new openness suggests that researchers around the world may be given greater opportunity to examine some of the most pressing scientific questions about the origins of the disease, its transmission and the number of viruses that may cause it.

One mystery is why AIDS, acquired immune deficiency syndrome, seems to be spread primarily by sexual intercourse among heterosexuals in Africa in contrast to its being spread primarily among homosexuals and intravenous drug users, as it is elsewhere in the world.

The first glimmer of greater openness could be seen several months ago when a few African countries began reporting a few cases to the World Health Organization. Many African governments had refused to report known cases, and in many countries the precise number of cases is unknown because the countries lack effective health surveillance systems.

At a meeting last week the wedge of candor had clearly grown into a much wider movement to carry out programs of research and prevention, according to Dr. Jonathan Mann, an American epidemiologist who heads the AIDS program for W.H.O., a specialized United Nations agency.

The franker discussion "is a major step forward," Dr. Mann said in a telephone interview after the close of the meeting in Brazzaville, Congo, in which representatives of 37 nations in Africa and around the world participated. It was the third meeting sponsored in the last year by the World Health Organization, which has come under criticism for not acting more forcefully against AIDS in the past.

Dr. Mann attended both earlier meetings as an AIDS researcher in Zaire. At the first, at Bangui in the Central African Republic, in October 1985, "it was difficult to talk about AIDS in Africa and to openly share information about it," he said, because of the reluctance to admit its existence there.

At the second meeting six months ago in Brazzaville, the discussion was limited to the general need to do something about AIDS in Africa, Dr. Mann said.

Last week's meeting was a marked contrast with "a minimum of defensive behavior," Dr. Mann said. "AIDS was openly discussed as if it were malaria, or diarrheal diseases, or measles" or similar major public health problems.

By dealing with AIDS directly, Dr. Mann said, "the governments will gain a limited measure of mastery over a problem that otherwise threatens to be overwhelming."

At least 74 countries worldwide have reported to W.H.O. on cases of AIDS, an incurable, fatal disease that, as it destroys the body's immune system, leaves its victims vulnerable to a host of opportunistic infections. It is caused by viruses that spread through sexual intercourse or exchanges of blood or blood products. Scientists have identified two viruses that can cause AIDS. They have also discovered a third virus that is closely related biologically, but it has not been reported to cause disease.

Measures to Combat Disease

Among the steps to combat its spread discussed at the Brazzaville meeting were the following:

* Formation of broad-based national AIDS committees to encourage widespread education and strong public health measures.

* Establishing an AIDS surveillance system and making initial epidemiological surveys and assessments of the potential costs and logistics of an AIDS campaign in each country.

* Developing the laboratory capability for doing AIDS blood tests to improve the accuracy of diagnosis and surveillance.

* Educating all health workers about AIDS.

* Encouraging physicians to provide sex education to patients. Funds to Assist Africans

Dr. Mann said the World Health Organization told the African nations that it now has the funds and strategy to assist in the battle against AIDS.

"We said if this is something you want to do, then we will help by first sending an expert on AIDS to assess and devise a plan," he said. "There are a lot of possible scenarios, such as pilot projects in hospitals and ways of doing a better job in sterilizing needles."

Health workers in Africa often use the same needle for several people without sterilizing it between injections. Contamination of needles is thought to contribute to the spread of AIDS in Africa, though how large a role that plays there is unknown.

Most experts believe that the spread of AIDS in Africa is principally through heterosexual intercourse. Elsewhere, AIDS has spread mainly among homosexual males, intravenous drug users, hemophiliacs and other recipients of blood products. Experts have not yet been able to explain the strikingly different epidemiologic patterns of the disease in Africa and other continents.

Cases in Children Studied

There are many AIDS cases among African children. Many are born to mothers who are infected with the viruses that bring on the disease. Many other cases result from transfusion with contaminated blood and some may be due to contaminated needles. At least four studies are under way in Africa to determine the risk factors in the spread of AIDS to newborns, Dr. Mann said.

He said that after the meeting, representatives of about 15 countries discussed tentative plans for consultations. Already, two Central African countries, which Dr. Mann declined to name, have asked the health organization for consultants to help develop a program for the prevention of sexually transmitted diseases in urban areas.

By the end of this year, Dr. Mann said, his health agency will send consultants to about eight countries with the expectation that programs will promptly be undertaken.

Dr. Mann said the World Health Organization also expected to help conduct behavorial, sociological and anthropologic studies to learn more about sexual practices. Experts recommend the use of condoms to help prevent AIDS.

However, Dr. Mann said, "Until one knows what men and women think about condoms, why many use them, why many others do not, what their concerns are, and a whole range of other things, it is hard to design a very effective program against AIDS."

861117
NYT861123